Corrective Dome Osteotomy Using the Paratricipital (Triceps-sparing) Approach for Cubitus Varus Deformity in Children

Abstract

Dome osteotomy has been described extensively in literature to correct posttraumatic cubitus varus deformity in children. Most case series on dome osteotomy using the posterior triceps-splitting approach report a decreased postoperative range of motion (ROM). We prospectively analyzed the results of dome osteotomy using the soft-tissue preserving paratricipital, (triceps-sparing) approach with respect to correction of deformity and preservation of elbow ROM. During 2006 to 2009, 24 children with cubitus varus deformity after supracondylar humerus fracture were treated with a dome osteotomy using the triceps-sparing approach. The follow-up period varied between 22 and 36 months (average, 27.6 mo). The average interval between injury to surgery was 26.7 months. The average age of the patients was 9.2 years. The average preoperative carrying angle (humerus-elbow-wrist angle, HEW) was -17.1 degrees (range, -8 to -30 degrees), whereas the average postoperative carrying (humerus-elbow-wrist) angle was +11.7 degrees (range, -12 to +16 degrees) with a mean correction of 28.8 degrees. The average preoperative ROM in the flexion/extension arc was 126.8 degrees and the average postoperative ROM was 132.1 degrees (range, 110 to 140 degrees). The lateral condylar prominence index changed from an average of -9.5% preoperatively to an average of -15.2% postoperatively. Excellent results were seen in 14 patients, whereas 9 had a good outcome. Supracondylar humeral dome osteotomy using the paratricipital approach for cubitus varus deformity allows correction of deformity, prevents lateral condylar prominence and avoids loss of elbow motion. IV.